SLR Graft Jacket

CrysLednum

Guru
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103
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Charm City - Baltimore
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Hi -

Surgeon uses a Graft Jacket SLR during a scapholunate interosseous ligament reconstruction. When looking at the vendor's description, it states, it's an acellular dermal matrix that provides complex three-dimensional array of proteins the interact with each other and with the host cells. It includes networks of collagen, elastin and proteoglycans. When asked, the surgeon stated this is non-biodegradable product and acted as a scaffold in the repair.

My question is, would this be a separately reportable code? The primary procedure is 25320. When I go onto CodeX, this type of graft is not included. It included prep and insertion of DBX, methmethacrylate and hydroxyapatites but I don't see anything about the graft jacket. So would coding for 11981 (insertion of non-biodegradable implant) work? Would a graft that meshes and produces this network of proteins to the ligament count as this?

Thanks!
 

JMeggett

Guru
Messages
226
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Hi -

Surgeon uses a Graft Jacket SLR during a scapholunate interosseous ligament reconstruction. When looking at the vendor's description, it states, it's an acellular dermal matrix that provides complex three-dimensional array of proteins the interact with each other and with the host cells. It includes networks of collagen, elastin and proteoglycans. When asked, the surgeon stated this is non-biodegradable product and acted as a scaffold in the repair.

My question is, would this be a separately reportable code? The primary procedure is 25320. When I go onto CodeX, this type of graft is not included. It included prep and insertion of DBX, methmethacrylate and hydroxyapatites but I don't see anything about the graft jacket. So would coding for 11981 (insertion of non-biodegradable implant) work? Would a graft that meshes and produces this network of proteins to the ligament count as this?

Thanks!
Our docs use these Graft Jackets once in awhile when doing RCR's. We add -22 to the CPT on the Professional claim to represent the additional work and then bill out Q4107 on the Facility (ASC) claim for reimbursement of the actual supply.
Jenna
 

JMeggett

Guru
Messages
226
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Thanks! Didn't even think about the 22! Have you been successful in capturing increased revenue?

:D
Yes, I type up a letter to send with the claim explaining exactly why the case is "above & beyond" the usual. Of course sometimes there are those claims that we can't get them to pay additional no matter what! :)
 
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